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Helping Your Child Carbohydrate Count The carbohydrate (carb) counting meal plan matches insulin to the food you eat. This gives you more freedom to choose the foods you want while keeping your blood sugar levels in control. What is a carbohydrate (Carb)? Carbs are the body’s best source of energy because they are the easiest to use. Carbs, or glucose, is the only form of energy that the brain can use. It is not healthful to cut carbs out of your diet. It is best to choose healthful sources of carb. Where can I find Healthy Carbs? There are three types of carbs: sugar, starch, and fiber. Sugars are the simplest form of carb and the easiest for the body to use. They are often called “quick carbs.” Starches are the largest form of carb and take the body longer to use. Healthy sources of carbs are high in fiber. Try to choose grains that have at least 3 grams of fiber per serving. Non-starchy vegetables like lettuces, tomatoes, broccoli, cauliflower and many others have small amounts of carb. They are also great sources of fiber. The amount of carb that your body needs is based on your height, weight, and activity level. Sugars Choose this… Whole fruit Vegetables Low-fat dairy, yogurt and cheese Starches Choose this… Whole grains (100% whole wheat bread, brown rice, whole grain pasta, quinoa, buckwheat, etc.) Whole grain cereals (oatmeal, cold cereals with < 8 grams of sugar) Beans, lentils, and split peas Starchy vegetables (potatoes, peas, winter squash and corn) Limit this… Fruit juice and Fruit-flavored drinks Sports drinks Soda Chocolate milk Candy Desserts Limit this… Refined grains (white bread, white rice) Sweetened cereals with > 8 grams of sugar) Chips Desserts (Cakes, Pies, Cookies) How do carbs affect blood sugar levels? Carbs increase blood sugar levels more than protein and fat. Almost all (90-100%) of carbs eaten affect the blood sugar within 20 minutes. Sugars affect the blood sugar faster than starches. Some starches will take almost an hour to affect the blood sugar. A general rule is that 1 gram of carb will raise blood sugar levels 3-4 mg/dl. How do protein and fat affect blood sugar levels? Protein and fat eaten without carbs have little effect on blood sugar levels. When they are eaten with carbs, they can help the blood sugar to rise and lower more slowly. Meals that are high in fat and protein, like pizza, may cause the blood sugar level to rise and stay high for 2-3 hours after eating. Where can I find lean protein? Fish Skinless chicken, turkey Dairy (milk, cheese, yogurt) Lean beef, bison and venison Lean pork Tofu and soy products Beans and split peas Nuts and seeds Where can I find healthy fat? Nuts and seeds Peanut butter and other nut butters Olive oil and olives Avocado STEP 1: Carb Identification The food label is a great place to get carb information. For homemade foods or foods without a label, use the following resources to estimate the amount of carb in those foods: Carbohydrate counting books/food list Fast food and restaurant menu nutrition information Websites and smart phone apps The resources found on pages 4-5 STEP 2: Reading a food label for carb content The Nutrition facts label is a great place to find how many carbs and what time type of carbs are in a food. The Serving Sizes tells you how much of the food has 37 grams of Total Carb The Total Carbohydrate tells you how much carb is in one serving size. This food has 37g Carb in 2/3 cup. 2 STEP 3: Practice carbohydrate counting 1. Practice carbohydrate counting by keeping a food log for 1-2 weeks. Use the Food Record for Carb Counting form at the end of the handout. Keeping track will show you how foods affect your blood sugar. Are there carbs that affect your blood sugar more than others? How does exercise affect your blood sugar? How long do you go without eating in between meals? Is there a pattern of low or high blood sugars? 2. Measure the food you eat. Use measuring cups and spoons or a food scale to help you figure out the amount of food you eat. Write down the portion sizes in your food log. To make this easier, consider measuring your glasses and bowls so you know how much they will hold. 3. Check your blood sugar before you eat and 2 hours after the start of your meal. Write down these blood sugar levels in your Food Log. Food Record for Carb Counting – Example Write down every food you eat and drink, along with the amount, and the grams of carb for each item. Add up the grams of carb for each meal. Check your blood sugar (BG) before meals, and two hours after meals. Record the foods and number in the food record for Carb Counting table. Time 7:14 AM BG Food Amount (e.g. cups, ounces) 2 slices g carb Insulin taken BG ~ 2 hrs later Time you tested after meal 30 g Humalog 3units 156mg/dl 9:05AM 2 tsp -- 2 -17 g Coffee (w/Splenda®) 1½ cups 2 cups Skim milk (in coffee) 4 Tbsp 3g 112 Whole wheat toast Margarine Poached eggs Fresh strawberries 10AM Medium apple 1 String cheese 1oz -- Total=50g Divide total by ratio to get units of insulin and then add for correction if needed. 25g 1g Total=76g Let long acting insulin cover snacks of 15-30 grams of carb. 3 STEP 4: Fine tuning Consistency with Carbs It is important to feed your body energy (carbs) throughout the course of the day. Eating carbs throughout the day helps to keep blood sugar levels stable. It also helps to keep you satisfied between meals. Fiber in Meals The amount of fiber in a food can affect your blood sugar because it is not completely digested, delaying your rise in blood sugar. Foods that have 2-3 grams of fiber will not affect your blood sugar levels much. Sugar Alcohols Sugar alcohols like maltitol, mannitol, sorbitol, and xylitol are used in “sugar-free” foods. They have calories and can raise your blood sugar slightly, but not like regular sugar does. Eating more than 10 grams of sugar alcohols can cause gas, bloating, and/or diarrhea. Everyone is Different Your body will respond in its own way to food that you eat. That response may be different compared with someone else who has diabetes. Keep a food log with your blood sugars to find out which foods affect your blood sugar the most. Foods to watch out for are casseroles, fried foods, and high fat desserts. Resources Cookbooks American Diabetes Association Complete Guide to Carb Counting: 2nd Edition by Hope Warsaw and Karmen Kulkami. 2004 The Diabetes Carbohydrate & Calorie Counter: 3rd Edition, by Annette B. Natow and Jo-Ann Heslin. 2006. The Ultimate Guide to Accurate Carbohydrate Counting by Gary Scheiner, 2006 American Diabetes Association Guide to Healthy Restaurant Eating by Hope S. Warshaw. 2009. The Calorie King Calorie, Fat, & Carbohydrate Counter 2011, by Allen Borushek. 2011. Scales EatSmart Digital Nutritional Scale (www.amazon.com) Nutri-Way Dietary Computer Scale (www.intergrateddiabetes.com) Salter Digital Nutritional Scale (available at Williams-Sonoma) Diabetes Nutrition Websites www.nutritiondata.com www.fitwatch.com www.sparkrecipe.com www.fatsecret.com 4 There are websites that offer food tracking and recipe analysis tools. These are great tools if you would like to know the carbohydrate and nutrition facts for common foods, meals or favorite recipes. These same sites may also have free recipes to try, or to compare to your favorites. All of these tools are free, except Calorie King. Calorie King requires a subscription. My Food Advisor from the American Diabetes Association (see http://tracker.diabetes.org/) Your Food Advisor can help you set specific goals for calories, carbohydrates and other nutrients. It can also track what you eat with great detail. This site also offers Create A Dish. This can help you calculate the nutrition content of favorite recipes. The recipe information includes carbohydrate grams per serving. ChooseMyPlate.gov offers Super Tracker, a free food, fitness and recipe tool. See https://www.supertracker.usda.gov/default.aspx. You can use Super Tracker to see how your daily meal choices compare to food group targets and daily limits. The section My Recipe allows you to build and analyze your favorite recipes to find out carbohydrate content and more. NutritionData.com also has free food search, meal tracking and recipe analysis functions. See http://nutritiondata.self.com/. The American Heart Association also offers recipes that include nutrient content in their Nutrition Center. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/Recipes/Recipes_UCM_001184_SubHomePage.j sp CalorieKing.com (http://www.calorieking.com) has a free food search function. It does require a subscription to use their Food Diary, goal setter, activity planner and charts and graphs. Phone/Tablet Apps iPhone Apps Android and iPhone Apps Android Apps Blackberry Apps Diabetes Companion Cost: Free Diabetes Log Cost: Free Glooko Cost: Free Carb Counting with Lenny Cost: Free CarbsControl Cost: $1.99-2.99 Calorie Counter Access at Fat Secret.com Cost: Free WaveSense Diabetes Manager Cost: Free Blue Loop Cost: Free On Track Diabetes Cost: Free Recordit Cost: $5.99 Go Meals, by CalorieKing Cost: Free Islet—Diabetes Assistant Cost: $0.99 Carb Master Cost: $0.99 Lose It! by Fitnow Cost: Free Nutrition Database for iPhone Cost: $4.99 5 FOOD RECORD for Carbohydrate Counting Write down every food you eat and drink. Include the amount, and the grams of carbohydrate your foods have. Total up the grams of carb for each meal. Check your blood glucose (BG) before meals, and about two hours after meals. In this way you begin the process of understand the effect of medicine, carbs and activity on your blood sugar. Time BG Food Amount (e.g. cups, ounces) g carb Insulin Taken . 6 BG ~ 2 hrs later Time you tested after meal Teach Back: What is the most important thing you learned from this handout? What changes will you make in your diet/lifestyle, based on what you learned today? If you are a UW Health patient and have more questions please contact UW Health at one of the phone numbers listed below. You can also visit our website at www.uwhealth.org/nutrition. Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s Hospital (AFCH) can be reached at: (608) 890-5500. Nutrition clinics for UW Medical Foundation (UWMF) can be reached at: (608) 287-2770. Your health care team may have given you this information as part of your care. If so, please use it and call if you have any questions. If this information was not given to you as part of your care, please check with your doctor. This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health needs are different, you should talk with your doctor or others on your health care team when using this information. If you have an emergency, please call 911. Copyright 3/2015 University of Wisconsin Hospital and Clinics Authority. All rights reserved. Produced by the Clinical Nutrition Services Department and the Department of Nursing HF#342 7